An October 27 New York Times editorial“Barack Obama for Re-Election” sums up the
case for more government spending.

“Allowing
children under 26 to stay on their parents’ policies; lower drug costs for
people on Medicare who are heavy users of prescription drugs; free
immunizations, mammograms and contraceptives; a ban on lifetime limits on
insurance payments. Insurance companies cannot deny coverage to children with
pre-existing conditions. Starting in 2014, insurers must accept all applicants.
Once fully in effect, the new law would start to control health care costs. “

The
main problems with line of reasoning is that since Obamacare” enactment in
March 2010:

·Health care premiums have soared by $2500 per
family

·Businesses have postponed hiring because of uncertainties
of Obamacare costs

·Estimates of its costs have grown from $900 billion to $2.6 trillion

·Employers
have dropped up to 20 million from health coverage

·The ACAremains unpopular with the public
which favor its repeal by 54% to 39%

·And the GOP has further neutralized its
appeal bymaintaining that Obama cut
$716 billion from Medicare to fund Obamacare.

To
complicate matters,the public is schizophrenic
about Obamacare.The
public disfavors Obamacare as a whole. According to Kaiser Health News,there are those who like the law,those who understand it, and those who want
to repeal it.A nationwide survey,
conducted between 2010 and 2012, of 2000
peopleindicated the following when
participants were given 18 statements about the law and asked to judge their
correctness. For example, 80% knew the law allowed young people to stay on the parents’
policies under age 26 and that companies with more than 50 workers were required
to offer coverage, but beyond those two provisions,few participants were able to judge any other provision with any
certaintyas true or false.

Why
this lack of understanding?The first reason
may be that reworking 1/6 of the complex health care economy is a matter of
daunting complexity that effects different Americans in different ways.A second reason may be that so far in the nearly 3 years after its implementation, less
than 30 million of our population of 310
million has so far been directly impacted by the Affordable Care Act.A third reason may be that the two political
parties spins its impacts differently.A
fourth reason,as articulated by
Jonathon Oberlander, an Obama supporter, in “Beyond Repeal – The Future of Health
Reform,” New England Journal of Medicine, December 9, 2010, it that “The law is
not a single program.It is a collection
of mandates, public insurance expansions, and regulationthat affect different groups of
Americansin different ways at different
times.”

Tweet:Health reform resembles the systole and
diastole of the human heart, systole being more government spending,diastole being market discipline.

Tuesday, October 30, 2012

Notable
and Quotable: Obamacare Is Even More Unpopular Now than in 2010

Wall Street Journal blog, By Jeffry H. Anderson.

October 30, 2012

Preface:Since I started this blog in November 2006,
I have often criticized Obamacare and pointed to its unpopularity Among the
American public.The article below
confirms my reading of the political tea leaves.How big a role this unpopularity will not be
known until the exit polls after the election are evaluated.In the meantime,Romney might be smart to repeat his pledge
tostart to repeal Obamacare on the day
he takes office.

“According to newly
released polling from Rasmussen Reports, by a margin of 15
percentage points (54 to 39 percent), likely voters now support the repeal of
President Obama’s centerpiece legislation. In the first three polls taken in
the wake of the House’s passage of Obamacare (on March 21, 2010), Rasmussen
showed that likely voters then favored repeal by margins of 13 points (55 to 42
percent), 12 points (54 to 42 percent), and 12 points (54 to 42 percent).
Cementing Obamacare would be the principal
focus of Obama’s second term.”

“The repeal of Obamacare is now
supported by men (by 24 points), women (by 7 points), voters between the ages
of 40 and 64 (by 22 points), seniors (by 32 points — and better than 2-to-1),
Republicans (by 75 points — and better than 7-to-1), independents (by 9
points), those who make less than $20,000 annually (by 15 points), those who
make between $20,000 and $40,000 (by 18 points), those who make between $40,000
and $60,000 (by 12 points), those who make between $60,000 and $75,000 (by 35
points — and better than 2-to-1), those who make between $75,000 and $100,000
(by 12 points), those who make $100,000 or more (by 3 points), those who work
for private companies (by 6 points), those who are entrepreneurs (by 28
points), those who are retired (by 30 points), those who didn’t graduate from
high school (by 49 points — and better than 3-to-1), those who graduated from
high school but haven’t attended college (by 51 points — and better than
2-to-1), those who went to college but haven’t graduated (by 29 points), and
those who graduated from college but haven’t attended graduate school (by 8
points).”

“The repeal of Obamacare is opposed
by voters under the age of 40 (by 4 points), Democrats (by 40 points — and
better than 2-to-1), government employees (by 3 points), and those who have
attended graduate school (by 10 points) — in other words, by Obama’s core
constituency.”

“The more often Mitt Romney mentions
Obamacare in these closing days (on the stump and especially in TV ads), the
more likely he is to become the next president of the United States”

Tweet:Obamacare is more unpopular than ever by a margin of 15%, particularly among Republicans, entreprenuers, retirees, and those who aren't college graduates.

Monday, October 29, 2012

You can never tell what innovators will do when left
to their own devices.Anonymous

October
29, 2012 - Hold your breathe.We are about to enter a fast-pacednew chapter on the use ofIphone generated ,wireless sensors, tablet-transmitted medical innovation.Apple’s IPhone series started the stampede,Samsung, Motoral , Amazon, Google, and
Microsoft, which just introduced it Windows 8 device, are in the hunt.

Where
the wireless high-speed bandwagon will go, no one knows. But several things are certain.

The
new devices and apps will allow:

·Physicians to monitorpatients at a distance – for routine
checkups, forfunction of implanted or
wearable devices,for condition en route
to the hospital whetherthey be on
stretchers or in emergency vehicles.

·Patients to monitor themselves from
home or work or during travel. At home or abroad.

·Cardiologists to look directly into
the heartand to view its muscles,
valves, muscles,and rhythm.

·Doctors to view images of MRIs,CT scans, and electorcardiograms

One
another note.This is not the first time
I have commented on mobile devices,

Here
is a previous blog I wrote on the subject dated December 12, 2011

Preface: Anthony Regalado, business editor of the MIT Press’ Technology
Review (http://www.technology review.com/business/39216) sent me the following
article, which will appear in Technology Review today.

The author of the article is Eric J. Topol, Chief Academic Officer of Scripps
health. It is an important contribution to the health care innovation debate.
Topol is also author of The reative Destruction of Medicine: How the Digital
Revolution Will Create Better Health.

"Medicine Needs Frugal Innovation," Technology Review“A low-cost pocket ultrasound device
can see into the human heart. So why do so few doctors use it?”
“In the history of medical innovation, advances in technology have been
inextricably linked to increases in cost. But we are at a unique moment in
which the insular world of medicine is about to be penetrated by the remarkable
digital infrastructure. Think about the cost of computing. Over the past two
decades, cost has been relentlessly reduced while capacity and performance have
dramatically increased. How and when can this trend reach the practice of
medicine, where costs often go up with little real improvement?”

“Let's consider the icon of medicine—the stethoscope draped around the doctor's
neck or in the pocket of a white coat. Invented by René Laënnec in 1816, the
stethoscope didn't see routine use by the medical community for another 20
years. The lag in acceptance reflected the conservative nature of physicians,
who objected to having to learn heart sounds and let an instrument get between
their healing hands and the patient. “

“Now, nearly 200 years later, economic forces are greatly slowing the adoption
of a powerful replacement for the stethoscope in cardiac medicine. Instead of
listening to the heart of a patient, I can now watch it on a device no bigger
than a cell phone—a high-resolution miniature ultrasound probe. In fact, in my
clinic I have not used a stethoscope to examine a patient's heart for the past
two years. “

“Why would I listen to the "lub-dub" of heart sounds when I can
actually see everything relevant about the heart in real time? Exquisite
ultrasound images of the heart muscle—showing its contraction, its thickness,
the size of the chambers, the valves, the sac around the heart—can all be
obtained within seconds as part of a routine physical examination. I can share
and discuss the images with the patient as they are being acquired, put video
recordings in the electronic medical record, and send them to the patient or
referring physician. The up-front cost of the pocket ultrasound device is about
$7,700, but there is no extra cost for an unlimited number of readings. “

“That makes these small devices a formidable challenge to business as usual in
American health care. Each year in the United States more than 20 million
echocardiograms (ultrasounds of the heart) are performed, and so are a similar
number of abdominal and fetal ultrasound examinations. Each of these diagnostic
procedures is done in a dedicated laboratory setting, either in the hospital or
in a doctor's office, with expensive equipment—and a combined professional and
technical charge of $1,000 to $2,000. The math is straightforward. If a pocket
ultrasound device were incorporated into routine physical exams the same way we
use a stethoscope, several billion dollars in unnecessary charges would be
saved each year.”

Therein lies the rub—and the explanation for why many low-cost innovations are
being held back in medicine. Those savings would represent a critical hit to
revenue for doctors and hospitals. It's not just that doctors, like those who
refused to use the stethoscope, are intrinsically conservative. The American
health-care model of billing "medicine by the yard" creates economic
disincentives to cost-saving technology. In contrast, pocket high-resolution
ultrasound has been rapidly adopted and hailed as a breakthrough in countries
such as India, China, and Brazil.”

“This represents just a single, simple example of how frugal innovation—the
idea of coupling engineering creativity with lower costs—could be achieved if
patient care in the United States were not determined by reimbursement rules.
We now have wireless sensors that can help us diagnose sleep apnea by capturing
all the relevant data for sleep studies—respiratory rate, oxygen saturation of the
blood. The data can easily be captured for less than $100, right in a patient's
home. But instead, the medical community keeps using $3,000-per-night hospital
sleep labs to make the diagnosis.”

“I believe a great inflection is coming in medicine: advances in technology
will finally help us override the reimbursement issue and topple the economic
models that physicians, insurers, and hospitals still cling to. This moment
will arrive as medicine is opened to the digital infrastructure of mobile
wireless devices, pervasive connectivity, ever-expanding bandwidth, cloud and
supercomputing power, and the Internet. “

“Superimposed on these digital capabilities are the ones specific to health
care—genomic sequencing, biosensors, advanced imaging, and health information
systems. It will all lead to what I call "high-definition man": a
panoramic, granular profile of an individual's molecular biology, physiology,
and anatomy.”

“Medicine, in short, has the potential for better technology at a much lower
price, but don't look to the medical profession, government, or the
life-sciences industry to make the change on its own. I believe the change will
come when consumers demand it. The Arab Spring and the Occupy Wall Street
movement have shown the influence of social networks as a way to express
citizens' demands. Don't be surprised if health care is occupied next. “

Fitting and Proper Close

It is altogether fitting and proper that I close with this perverse verse.

Sunday, October 28, 2012

October 28, 2012 - Sometimes what’s important hits us like a thunderbolt right
under our noses.

I had a farm in Minnesota, 30 miles from my suburban home. My
wife and I spent my day off and weekends there. A farmer of Czech heritage,
Ladislav Malecha, took care of the farm for us. We would rush to the farm, then
hastily rush back to the city. One day the farmer said to us, “What’s the rush?
What’s more important than spending time with me?”

What indeed? Human beings judge their value to other human
beings by time spent with them. Spending time with the doctor is what impresses
patients. It is why they came to see you. Nothing irritates patients more than
sitting idly in the reception or exam room, waiting for you. No more important
use of your time than spending your valuable time with patients. What’s more
important?

Other doctors, smarter and more insightful than me, have brought
the importance of time to me over the years.

·In December 2006, I wrote a series of 20 posts on how to build
patient trust. The first blog post in series contained this paragraph.

“Dr. Randall Oates, a family physician in
Arkansas, for example, decided he would only see complex patients requiring a
physician’s professional knowledge; he would delegate to staff all other
patients being seen for other reasons. His decision made better use of his time
and increased coding revenues." Randall has since gone on to form an EHR company
called SOAPware, which produces easy-to-use software that saves clinicians
time.

·In January 2010, I
wrote a post with the title “Physicians Business Ideas for Practice
Productivity: Why Not Let Patients Enter
Data””The post chronicles the story of
Allen Wenner, MD, of Columbian, South Carolina.Wenner pioneered and developed software, consisting of patient-centered
software consisting of patient-enterable clinical algorithmswherein patient could enter their
demographics, chief complaint, and history by answering simple “yes” or “no”
questions.The output was called the
Instant Medical History. which saved the doctor 6- 8 minues of history-taking
time with each patients.

·In May 2010 in “Practice
Interruptus: Those Invisible, Inevitable Interruptions,” I told the story of
Wesley Curry, MD, a A California ER Physician.”Curry said the computer was a big time interrupter.He spend 2-3 hours each workday logging in,
inputting, or requesting information, and logging out of 6 to 8 software
programs that had become mandatory in the patient encounter. One program was
for obtaining lab results, one for X-ray, one for discharge, one for recalling
past charts, and so forth.Each log-in
or log-out required more time for getting through the various security screens
which shut down the program if there was no activity for a few minutes when the doctor is away seeing
patients. Logging in or out takes at least 30 seconds to one minute for each program,
and in aggregate takes a significant amount of time which could be used to see
patients. These programs helped retrieve useful information and document the encounter,but Curry asserted, had little value
in creating real time efficiency.Electronic records were simply not clinically
useful.Curry’s solution wasto hire a scribe to follow him around,entering information and opening and closing
programs.

·In January 2011 “In
Saving Time and Practicing Better Medicine “ I commented at length:

“In The Successful Doctor: A Productivity Handbook for
Practitioners (An Aspen Publication, 2000), Marshall O. Zaslove, MD, a West
Coast physician who conducted productivity seminars for doctors, gave a few
hints on how to save time while conducting a better, more productive practice.

1) Realize you’re the highest paid person in your practice, and you’re paid to
see patients at the rate of $3 to $4 per minute.

5) Have patients in the reception room write down three questions that concern
them the most. This will allows you to get to the heart of the problem quickly.

6) Look into acquiring instantmedicalhistory.com software. This allows patients
to generate their own history based on their chief complaint, age, and gender,
before or during their visit, saving you 4 to 8 minutes per patient visit.

7) Ask your nurse or other members of your staff how you can do things better
and faster. Often they’ll tell you practical things they’ve been dying to tell
you for years.

11) Be careful how you use the phone. It takes up to 1/3 of some doctors’ time.

12) Consider charging for patient emails, and substituting these emails for
phone calls.

13) Consider hiring a scribe to record relevant historical information and to
enter data.

14) Consider installing an EMR but not until it is ready for prime time, saves
time, boosts productivity, and is useful for communicating with others.

15) Consider applications of mobile devices to increase productivity – look for
successful examples.I could go on, but I
will not. Instead, I will circle back to the opening quote an enter these
observations from Peter Drucker: “Time is a unique resource..The supply of time
is totally inelastic. No matter how high the demand, the supply will not go
up…Yesterday’s time is gone forever and will never come back. Time is,
therefore, in always in exceeding short supply. Time is totally
irreplaceable."

Tweet:What’s important to patients
is to spend time with doctors. That is what is important to doctors too. Listed here
are ways to create more time

Saturday, October 27, 2012

Understanding Two Economic and Political Realities
of Health Reform in the 2012 Election as Revealed by 37 Independent
Telephone Polls

The
end of understanding is not to prove and find reasons, but to know and believe.

Thomas Carlyle (1795-1881), Characteristics

October 27, 2012 – An article in the October 25 New
England Journal of Medicine “Understanding Health Care in the 2012 Election”reveals two economic and political realities
of the 2012 election in a project supported
by the Robert Wood Johnson Foundation consisting of 37 independent telephone
pollsconducted among both land-line and
cell-phone respondents.

Reality
#1 -Health reform is important but it
is dwarfed by economic issues: 81% of
respondents indicate health care is an important issue, but 51% choose the economy and jobs as as
their top issue, compared to 20% for health reform.

The most important issues for voters by percentage
of respondents are:

Rank #1 – Economy and jobs, 51%

Rank #2 – Health care and Medicare, 20%

Rank #3 – Federal budget deficit and taxes, 14%

Rank #4 – Abortion, 4%

Rank #5 – War in Afghanistan, 2%, and Immigration, 2%

Reality
#2 – Respondents favor current government programs of Medicare and Medicaid but
this favoritism is unlikely to influence their vote.

Candidate’s position, 1. More likely to vote for this
candidate,2. Less likely to vote for
this candidate, 3. no position.

·Supports repealing all or parts of
national health care law passed in 2010,
14%, 41%, 45%.

·Supports changing Medicare so that people 64 years of age or
older receive a payment or credit from the government each year for a fiexed amount
that they can use to shop for their private health insurance plan or purchase
Medicare coverage,11%, 39%, 50%.

·Supports changing Medicaid, the health insurance
program for low-income Amerians, from the current system to one in which the
federal government gives states a fixed amount of money and each state decides whom to cover
and what services to pay for. 8%, 35%, 57%.

Source: Robert J. Blendon, John M. Benson, and Amanda Brule, from Harvard School of Public Health and John F. Kennedy School of Government, "Understanding Health Care in 2012 Election," New England Journal of Medicine, October 25, 2012.

Tweet:Most
voters favor current government policies on Medicare and Medicaid but economic
issues are more likely to influence for whom they vote.

Friday, October 26, 2012

A
man’s memory of his past may become the art of continually varying and misrepresenting his
past, according to his interest of the present.

George Santayana
(1863-1952), Persons and Places

October 27, 2012-A number of
people have been bringing my attention to Kimberly Strassel’s article “AChronic Case of Obamnesia” in today’s Wall
Street Journal.I feel it is imcubent
upon me to point out this Obamnesia extends to Obamacare – the fiction that premiums
will be cut by $2500 but instead have gone up $2500,that the public will like it once it has been
explained,that seniors will embrace it once they wee what's in it,
that it will extend access althouigh employers have thus far dropped health coverage for 20
million employees.

Here are Kimberly
Strassel’s 11 examples of Obamesia.***

1)"I happen to be a proponent of a
single-payer universal health care program"—Illinois state Sen. Barack
Obama, June 2003.

"I
have not said that I was a single-payer supporter"—President Obama, August
2009.

"It is not acceptable for us not to
raise the debt ceiling and to allow the U.S. government to
default"—President Obama, July 2011.

***

3)"I favor legalizing same-sex marriages,
and would fight efforts to prohibit such marriages"—Obama questionnaire
response, 1996, while running for Illinois state Senate.

"I
believe marriage is between a man and a woman. I am not in favor of gay
marriage"—Sen. Obama, November 2008, while running for president.

"It is important for me to go ahead and
affirm that I think same-sex couples should be able to get
married"—President Obama, May 2012.

***

4)"We have an idea for the trigger. . . .
Sequestration"—Obama Office of Management and Budget Director Jack Lew in
2011, as reported in Bob Woodward's "The Price of Politics."

"First
of all, the sequester is not something that I've proposed. It is something that
Congress has proposed"—President Obama, October 2012.

***

5)"If I am the Democratic nominee, I will
aggressively pursue an agreement with the Republican nominee to preserve a
publicly financed general election"—Sen. Obama, 2007.

"We've made the decision not to
participate in the public financing system for the general election"—Sen.
Obama, June 2008.

***

6)"I will never question the patriotism of
others in this campaign"—Sen. Obama, June 2008.

"The
way Bush has done it over the last eight years is . . . [he] added $4 trillion
by his lonesome, so that we now have over $9 trillion of debt that we are going
to have to pay back. . . . That's irresponsible. It's unpatriotic"—Sen.
Obama, July 2008.

"I don't remember what the number was
precisely. . . . We don't have to worry about it short term"—President
Obama, September 2012, on the debt figure when he took office ($10 trillion)
and whether to worry about today's $16 trillion figure.

***

7)"[Sen. Hillary Clinton believes] that .
. . if the government does not force taxpayers to buy health care, that we will
penalize them in some fashion. I disagree with that"—Sen. Obama, Jan 2008,
opposing the individual mandate for health insurance.

"I'm open to a system where every American
bears responsibility for owning health insurance"—President Obama, June
2009, supporting the individual mandate.

***

8)"Instead of celebrating your dynamic
union and seeking to partner with you to meet common challenges, there have
been times when America has shown arrogance and been dismissive, even
derisive"—President Obama, April 2009, in France.

"We
have at times been disengaged, and at times we sought to dictate our
terms"—President Obama, April 2009, in Trinidad and Tobago.

"Nothing Governor Romney just said is
true, starting with this notion of me apologizing"—Barack Obama, October
2012, on whether he went on a global apology tour.

***

9)"The problem with a spending freeze is
you're using a hatchet where you need a scalpel"—Sen. Obama, September
2008.

"Starting
in 2011, we are prepared to freeze government spending for three
years"—President Obama, January 2010.

***

10)"So
if somebody wants to build a coal-fired plant, they can, it's just that it will
bankrupt them"—Sen. Obama, January 2008, on his plans to financially
penalize coal plants.

"Now
is the time to end this addiction, and to understand that drilling is a
stop-gap measure, not a long-term solution"—Sen. Obama, August 2008.

"Here's
what I've done since I've been president. We have increased oil production to
the highest levels in 16 years. Natural gas production is the highest it's been
in decades. We have seen increases in coal production and coal
employment"—President Obama, October 2012.

***

11)"If
I don't have this done in three years, then there's going to be a one-term
proposition"—President Obama, 2009.

"We've
got a long way to go but . . . we've come too far to turn back now. . . . And
that's why I'm running for a second term"—President Obama, October 2012.

These
reversals may be a case of psychological “projection,”where the President “projects” faults of his own to his opponents. Whatever
the reason – projection or political expediency – this may simply be a case of
the pot calling the kettle black on the day after the President called Romney a
“bullshitter” and the Vice-President said the GOP ticket was full of “mulkarkey.”

Tweet:
Obamanesia
may be defined as forgetting what one has said in the past and reversing it to
fit present political contingencies.

Which of you, intending to build a tower, sitteth not down first, and
counteth the costs, whether he have sufficent to finish it?

The Holy Bible: Luke

Currently, the United States spends more on health care services than any
other country, exceeding $2.6 trillion, or about 18 percent of gross domestic
product.Most years, medical spending
rises faster than inflation or the economy as a whole. Many factors - and
nearly everyone- contribute to these increases.

October 26, 2012- In an excellent article,Julie
Appleby of Kaiser Health News
identifies seven factors contributing to high health costs but no single villain.

1.Pay our doctors, hospitals and other medical
providers in ways that reward doing more, rather than being efficient.

2.We're growing older, sicker and fatter.

3.
We want new drugs, technologies, services and procedures.

4.
We get tax breaks on buying health insurance -- and the cost to patients of
seeking care is often low.

5.
We don't have enough information to make decisions on which medical care is
best for us.

6.
Our hospitals and other providers are increasingly gaining market share and are
better able to demand higher prices.

7.
We have supply and demand problems, and legal issues that complicate efforts to
slow spending.

The Malpractice, Defensive Medicine Factor, and Scope of Practice Factors

Of the last factor, she says: “Malpractice
premiums and jury awards are part of what drives spending. A larger problem,
although hard to quantify, is ‘defensive medicine’ -- when doctors prescribe
unnecessary tests or treatment out of fear of facing a lawsuit, the report
says. Fraudulent billing or unnecessary tests by medical providers seeking to ‘game
the system’ are another concern.”(This
is no doubt true. Defensive medicine may cost the system in the neighborhood of
$50 billion to $200 billion.No one
knows exactly how much. Fraud is estimated at $60 billion to $90 billion).

“Finally, the report notes that state laws
sometimes limit the ability of nurse practitioners or other medical professionals,
who are paid less than doctors, to fully perform work for which they are
trained. The U.S. faces a shortage of primary care doctors, so more advanced
practice nurses and others will be needed to help care for patients who gain
insurance coverage under the federal health law. Conversely, the U.S. has a
higher ratio of specialists than other countries, which can serve to drive up
spending. Specialists have more advanced training than primary care doctors,
and are paid far more( To complicate matters, U.S. patients often prefer to be treated by a specialist).

On Target

Julie is on target with her assessment.What
she is describing are the natural consequences of human nature under the
current system and are difficult to reverse.

·Doctors act in their own best interest to
enhance their income,Who, in similar circumstances, would not?

·We get sicker and thicker as we grow older.Aging
has consequences.

·As patients we want the very best for
ourselves. And for our families and other loved ones.

·We take advantage of tax breaks. Breaks are there for a reason, and special
interests make sure they stay there.

·Information may not available to judge
what is the best thing to do. And in
certain cases It may never be –
individual patients respond unpredicatably differently, and nature and disease are slow to
yield their mysteries.

·Doctors and hospitals flock together to
protect their turf and may end with virtual monopolies,Like it
or not,this is a consequences
of collaboration,which some may prefer to
call collusion.

·We have a doctor shortage, and our legal
system with the ever-present threat of being suedleads to high costs of defensive medicine. After all, one must protect oneself against
the accusation that one did not cover all the possible bases.

Other Factors - Left Brain and Right Brain Thinking

But there are other factors as well.These factors tend to be unspoken, intangible,subjective, and very human.

These factors boil down to left-brain thinking
vs. right brain thinking.

Left-brain thinking is scientific,
sequential, logical, and rests on piles of data.Number crunchers, federal bureaucrats and
others with green eye shades using computers,information technology techniques, and electronic health records can
easily compile,sift, analyze, dissect, parse,
and compose evidence-based data,
protocols,checklists, algorithms,
rules, and regulations purported to elevate quality and otherwise rationalize,
and if need be,ration care and
costs.But, instead, left brain rules,
with the time-consuming demand for data
entry, bureaucratic hassles, and concentration
on an all-inclusivechart, distracts
from patients, eats up time, and drives
up costs.

The right brain, the design mind,and the thinking it produces differs.Its thinking is based on pattern
recognition,intuitive leaps, clustering
and chunking to make sense of data, recognition of body language and verbal
cues,and the knowledge-based on experience
with thousands of patients,recognizes
that the human condition is full of vast immeasurable grayzones and personal conumdrums..The right brain can cut through the morass
of data and reach sensible and quick decisions without wading through
regulations and procedures designed to rationalize care.It humanizes care. It is an art based on
doctor-patient relationships, and sometimes goes by the name of bed-side
manner and human sense.It is a trait shared by many
superb diagnosticians and commonsensical doctors who can inexpensively and
quickly reduce medical and health
problems to their essence.

Tweet:Multiple
American cultural factors drive up costs
of care, and these factors do not always yield to data-driven and protocol -driven
care.

The Health Reform Maze

Buy the Book

Book Description: In this first book in a series of four, Richard L. Reece, MD. provides a unique view of the roll out, and run up, of the Affordable Care Act. Reece shows in this book the progress and facets of ObamaCare's marketers and messengers, as the day approached for the launch of health insurance exchanges - the single most public and problematic portion of the new law. This is a must read for anyone who wants to chronicle this attempt to organize more than one-sixth of the U.S. economy by adding layers of federal government control and regulations.

Reece has been writing about U.S. health care for more than 45 years. His knowledge and experience, added to his keen intellect and gift of subtle humor, make this book a valuable part of anyone's collection.